Conference PaperPDF Available

Beyond Self-Tracking and Reminders: Designing Smartphone Apps That Support Habit Formation

Authors:

Abstract

Habit formation is an important part of behavior change interventions: to ensure an intervention has long-term effects, the new behavior has to turn into a habit and become automatic. Smartphone apps could help with this process by supporting habit formation. To better understand how, we conducted a 4-week study exploring the influence of different types of cues and positive reinforcement on habit formation and reviewed the functionality of 115 habit formation apps. We discovered that relying on reminders supported repetition but hindered habit development, while the use of event-based cues led to increased automaticity; positive reinforcement was ineffective. The functionality review revealed that existing apps focus on self-tracking and reminders, and do not support event-based cues. We argue that apps, and technology-based interventions in general, have the potential to provide real habit support, and present design guidelines for interventions that could support habit formation through contextual cues and implementation intentions.
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

Katarzyna Stawarz
Anna L. Cox
Ann Blandford













        
      
          
       

  
        
 
       
 
        
     
       
        
      

      
      







       
  
       
      
  
   
 
       
     

            
           
        



        


         
  
       
      
   
    
  

         
       
      



      
 
    


 
     
      


         
  
         
        
     
       
      
          
       
       

 
         
   
         
      
  
      
   
        
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         
    
       

        
        
 
        
        



         

         
       
       


       
        
   



        
     
  

         
         



           
       

          




 
        
           

         
    
      

        

            
          


   
        

       
      
   

       
         

        

         



        
      
          
      
 
        
   

        
       


    
          
        



    
        
     
       
       

       
   
       

  



   


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
    
        
        



      
        



   

         
       
 
  
        
  

          
        
       
      
      
       
       
       
       
       


   
        
   
  
       
 
        

   


      
       



 
        

      

     

         
   

 
        
     
        
   
        
       

        
 
   
   
   



      
         
  
         

        

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


          
            
        

  
  



   
          

 
 


  
 
  

 


 
 
 



 
 
  


  


 

 

 
 



 
 


 
  



 



Positive
reinforcement
Cue
None
SMS
reminder
None




SMS
confirmation



Table 1. Independent variables and study conditions
Participants
       
         
       
         
       
          


Design
   × 
   ×  
  
        
  
    

  

        

      





No
cues
(Control)
group





















 

 
 
 

 

Reminder
and
positive
reinforcement
(R&PR)
group




























Materials







    
    
      


Procedure

          

        
   
       
         


        
   
       

         



        


 


        
       
         



















 

 
 

 

 
 


 

 

 
 




 


 



 
Automaticity






  
  
  

 




























η






η

 





  







 
   



 
η 


























 









Adherence





  

































 

Figure 1. Automaticity scores for study conditions grouped by
cue type: no cues (dark gray), event-based cues (light gray)
and time-based cues (white dotted)
Figure 2. Adherence scores for study conditions grouped by
cue type: no cues (dark gray), event-based cues (light gray)
and time-based cues (white dotted)
 
η

 




η




  
η


 
 












       

Remembering Strategies
      

       
      
  

        
         

   
 
          

       
 


       
          

Missing Positive Reinforcement Messages

   
       
        
        
    
          

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         


        

 
 

       

       

       
      
    
    
   

  



      
       
    
       
       
       
       
       
        



  

         

        
       
      
      


 
        
  
       
         
 







       

      
    
  
 
      
  
        
      


       
   
      
    
   



 
 
         
    
       




    
       
          
        
 
  
       
        
 
        
           
   
          

         
          
         
        
    
       
  
         

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        

       
      

     
       
     
     
         

 
  
       



Functionality

        
   
          
         
       
   
          
       
         
  

       
  
         
        
    
  
        



        
          
        
    
           
      
           
          

        

        

Figure 3. Functionality of habit formation apps (N=115)
Habit Formation Support


    
         
     

       
      
    
         
         
      
       
  

        
       
        

Behavior Change Techniques


     
 
         
  
        
        
    



     
       

      
        
       
 






 
 




 
 
 

 
 
 

  
   
  

  

 

 

 



  



 

 



  

 
 
 



 
 



 

















Functionality
Habit formation
elements
Behavior change techniques
Examples apps


















































Table 2. Apps functionality with corresponding elements of habit formation, behavior change techniques, and examples of
apps that provide such functionality. Apps marked with iare available for iOS and with afor Android phones.
   
        




       
  
  
     
   


      
  
        

    

      
       

         
       



         


        
       
   

          
       
     
       

       
  
         
 

        
       
         

 
  
      
         
        

      
        

       


 
 
  
 
 


 
 

 
 
 




 


 
 

 



Support trigger events
 



  


 
 








Use
reminders
to
reinforce
implementation
intentions 





 before






















































Avoid
features
that
teach
users
to
rely
on
technology.












 






























       

        


     
          
 
          

        
 


         
    



      
      


  
        
      
       

 
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 
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 
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 
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 
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 
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Health Education
Research
 
Organizational Behavior and Human Decision
Processes 
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
 
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
Proc. UbiComp 2008
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Health
Education
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Behavior
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American Pharmacists
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
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Philosophical
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the Royal Society of London. B, Biological Sciences

 
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PLoS
Medicine
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The
Interna-
tional Journal of Behavioral Nutrition and Physical Ac-
tivity
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

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


American
Psychologist

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






Memory
&
Cognition


In Proc. CHI 2011

Social Work Research & Abstracts


Health Psychology Review


European Journal of Social
Psychology

Psychology, Health &
Medicine

PR Web






Annals of Behavioral Medicine


Journal of Experimental
Social Psychology




Progress
in
behavior
modification


























Prospective
memory:
Theory
and
applications.


































Proc.
CHI
2014,













Health
Psychology


















Applied
Cognitive
Psychology,











New Relic




















Proc.
CHI
2014






















Psycho-
logical Review




















ABC
of
Behavior
Change:
A
Guide
to Successful
Disease
Prevention
and
Health
Promotion



















Journal
of
Applied Social
Psychology









. Journal
of
Public
Policy
& Marketing
















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... They were shown to increase water intake, adherence to chronic medication, and step count [25][26][27][28] . However, reminders also come with possible negative effects such as annoyance or hinderance of habit formation 32,33 , and their effects on students' study behavior are unclear. ...
... Whether in addition to one-off interventions or on their own, reminders can be sent repeatedly in people's daily lives. In this way, they can promote the recall and repetition of desirable behaviors 33 . However, simple repetition of a desired behavior in reaction to a reminder does not mean the desired behavior is performed automatically. ...
Article
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Reminders are a popular feature in smartphone apps designed to promote desirable behaviors that are best performed regularly. But can they also promote students’ regular studying? In the present study with 85 lower secondary school students aged 10–12, we combined a smartphone-based between- and within-person experimental manipulation with logfile data of a vocabulary learning app. Students were scheduled to receive reminders on 16 days during the 36-day intervention period. Findings suggest that reminders can be a double-edged sword. The within-person experimental manipulation allowed a comparison of study probability on days with and without reminders. Students were more likely to study on days they received a reminder compared to days when they did not receive a reminder. However, when compared to a control group that never received reminders, the effect was not due to students studying more frequently on days with reminders. Instead, they studied less frequently on days without reminders than students in the control group. This effect increased over the study period, with students becoming increasingly less likely to study on days without reminders. Taken together, these results suggest a detrimental side effect of reminders: students become overly reliant on them.
... Given the success of mHealth interventions at improving the scalability of many other behavioral techniques, such as the use of financial incentives (DiStefano & Schmidt, 2016;Gilson et al., 2017), there is reason to believe an mHealth solution also exists for implementing habit formation intervention techniques, such as anchoring. While several recent studies have described how mHealth tools could support contextual-cue-dependent habit formation (Stawarz et al., 2015), such methods have yet to be developed and rigorously tested. ...
Article
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The purpose of this study was to: (1) compare the relative efficacy of different combinations of three behavioral intervention strategies (i.e., personalized reminders, financial incentives, and anchoring) for establishing physical activity habits using an mHealth app and (2) to examine the effects of these different combined interventions on intrinsic motivation for physical activity and daily walking habit strength. A four-arm randomized controlled trial was conducted in a sample of college students (N = 161) who had a self-reported personal wellness goal of increasing their physical activity. Receiving cue-contingent financial incentives (i.e., incentives conditional on performing physical activity within ± one hour of a prespecified physical activity cue) combined with anchoring resulted in the highest daily step counts and greatest odds of temporally consistent walking during both the four-week intervention and the full eight-week study period. Cue-contingent financial incentives were also more successful at increasing physical activity and maintaining these effects post-intervention than traditional non-cue-contingent incentives. There were no differences in intrinsic motivation or habit strength between study groups at any time point. Financial incentives, particularly cue-contingent incentives, can be effectively used to support the anchoring intervention strategy for establishing physical activity habits. Moreover, mHealth apps are a feasible method for delivering the combined intervention technique of financial incentives with anchoring.
... It is also possible that group discussion limited people's willingness to discuss their finances and lay bare behaviours perceived to be negative. Stawarz and Blandford (2015) claimed reminder app functions could facilitate habit formation and behaviour change. The differences between these results may be explained by the level of autonomy the user feels (Villalobos-Zúñiga and Cherubini, 2020). ...
Preprint
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This study aims to gain insight into consumers' perceptions of the value of potential features of smartphone applications (apps) that are designed to reduce self-identified, unnecessary consumption of new clothes. This study involved five focus group discussions with 29 participants , the transcripts of which were thematically analysed. Focus group participants (FGPs) responded positively to app features that provided information and guidance on alterations at the tailor's shop, reminders of things 'you already own', recycling bin locations and charity shop information features. Participants rejected the need for a new app related to minimising new clothes purchases or facilitating resale, rental and sharing. Overall, participants were willing to include wardrobe management functionality as a core feature of any potential app. More than half of the participants felt wardrobe management could change their relationship with their existing clothing and minimise their self-identified harmful behaviour of seeking satisfaction in new purchases. Limitations include the small sample size, rendering the findings potentially less relevant to other populations. However, the participants came from a range of different educational backgrounds, countries and cultures and had variety of experiences in consuming fast fashion and using fashion apps. This study fills a research gap in our understanding of consumer perceptions of fashion apps and features designed to support behaviour change and reveals some surprisingly negative consumer responses to garment sharing and rental services. This is a pre-print of the following chapter: Gigi Jiang, Dr Lisa Macintyre, Prof. Marylyn Carrigan and Dr Agnessa Spanellis; Consumer perceptions of app functions designed to reduce unnecessary fashion purchases; published in Fashion for the Common Good, edited by Isabel Cantista · Elaine L. Ritch · Linda Shearer ·Silvia Pérez-Bou · Sonika Soni Khar, 2024, Palgrave Macmillan, reproduced with permission of Springer Nature Switzerland AG 2024. The final authenticated version is available online at https://doi.org/10.1007/978-3-031-50252-1
... In a growing technological age, and after a global pandemic where there was so much isolation between people and fewer face-to-face interactions, technological interventions for mental health issues have vast potential to provide accessible and affordable mental health care. The present study further serves to study the effectiveness of said technology, as called for in current research (Aguilera, 2015;Jameel et al., 2022;Lattie et al., 2022;Naslund et al., 2017;Stawarz et al., 2015;Taylor et al., 2020). ...
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Within current mental healthcare practices, a reliable mechanism is needed for transitioning therapeutic interventions into long-term habit formation. While a sizeable body of literature on habit formation and automaticity looking at simple behaviors such as overall activity level and diet exists, few studies have investigated the complex behavior formation needed to instill new beneficial mental health habits. Additionally, limited research has looked at the neurophysiological or biological correlates of these mental processes and changes. Madhavan et al. (2015) proposed that, during active learning or recall, individuals exert more cognitive energy compared to information maintenance, resulting in heightened gamma activity. This new data demonstrates that gamma increases as learning is taking place then decreases once the behavior is learned (habituated), providing evidence of habit formation and automaticity and its nonlinear nature. The current pilot study seeks to contribute to the field’s developing knowledge of habit formation and automaticity as something that can be deliberately and mindfully learned, through a planned and guided approach over a specified time frame, to empower individuals to achieve lasting improvements in mental health challenges. Our research contributes practical strategies to improve interventions and achieve sustainable outcomes for the public health emergency in mental health.
Chapter
This study aimed to gain insight into consumers’ perceptions of the value of potential features of smartphone applications (apps) designed to reduce self-identified, unnecessary consumption of new clothes. This study involved five focus group discussions with 29 participants, the transcripts of which were thematically analysed. Focus group participants (FGPs) responded positively to app features that provided information and guidance on alterations at the tailor’s shop, reminders of things ‘you already own’, recycling bin locations and charity shop information features. Participants rejected the need for a new app related to minimising new clothes purchases or facilitating resale, rental and sharing. Overall, participants supported the concept of wardrobe management functionality as a core feature of any potential app. More than half participants felt wardrobe management could change their relationship with their existing clothing and minimise their self-identified harmful behaviour of seeking satisfaction in new purchases. Limitations include the small sample size, rendering the findings potentially less relevant to other populations. However, the participants came from a range of different educational backgrounds, countries and cultures and had a variety of experiences in consuming fast fashion and using fashion apps. This study fills a research gap in our understanding of consumer perceptions of fashion apps and features designed to support behaviour change and reveals some surprisingly negative consumer responses to garment sharing and rental services.
Article
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Interventions to change everyday behaviors often attempt to change people’s beliefs and intentions. As the authors explain, these interventions are unlikely to be an effective means to change behaviors that people have repeated into habits. Successful habit change interventions involve disrupting the environmental factors that automatically cue habit performance. The authors propose two potential habit change interventions. “Downstream-plus” interventions provide informational input at points when habits are vulnerable to change, such as when people are undergoing naturally occurring changes in performance environments for many everyday actions (e.g., moving households, changing jobs). “Upstream” interventions occur before habit performance and disrupt old environmental cues and establish new ones. Policy interventions can be oriented not only to the change of established habits but also to the acquisition and maintenance of new behaviors through the formation of new habits.
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Despite the fact that a third of all cases of unintentional medication non-adherence are caused by simple forgetfulness, the majority of interventions neglect this issue. Even though patients have access to smartphone applications ("apps") designed to help them remember medication, neither their quality nor effectiveness has been evaluated yet. We report the findings of a functionality review of 229 medication reminder apps and a thematic analysis of their 1,012 user reviews. Our research highlights the gap between the theory and practice: while the literature shows that many medication regimens are habitual in nature and the presence of daily routines supports remembering, existing apps rely on timer-based reminders. To address this disparity, we present design requirements for building medication reminders that support the routine aspect of medication-taking and its individual nature, and demonstrate how they could be implemented to move from passive alerts to a smarter memory and routine assistant.
Article
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Objectives: To provide an overview of medication adherence, discuss the potential for smartphone medication adherence applications (adherence apps) to improve medication nonadherence, evaluate features of adherence apps across operating systems (OSs), and identify future opportunities and barriers facing adherence apps. Practice description: Medication nonadherence is a common, complex, and costly problem that contributes to poor treatment outcomes and consumes health care resources. Nonadherence is difficult to measure precisely, and interventions to mitigate it have been largely unsuccessful. Practice innovation: Using smartphone adherence apps represents a novel approach to improving adherence. This readily available technology offers many features that can be designed to help patients and health care providers improve medication-taking behavior. Main outcome measures: Currently available apps were identified from the three main smartphone OSs (Apple, Android, and Blackberry). In addition, desirable features for adherence apps were identified and ranked by perceived importance to user desirability using a three-point rating system: 1, modest; 2, moderate; or 3, high. The 10 highest-rated apps were installed and subjected to user testing to assess app attributes using a standard medication regimen. RESULTS 160 adherence apps were identified and ranked. These apps were most prevalent for the Android OS. Adherence apps with advanced functionality were more prevalent on the Apple iPhone OS. Among all apps, MyMedSchedule, MyMeds, and RxmindMe rated the highest because of their basic medication reminder features coupled with their enhanced levels of functionality. Conclusion: Despite being untested, medication apps represent a possible strategy that pharmacists can recommend to nonadherent patients and incorporate into their practice.
Article
Full-text available
Objectives: To provide an overview of medication adherence, discuss the potential for smartphone medication adherence applications (adherence apps) to improve medication nonadherence, evaluate features of adherence apps across operating systems (OSs), and identify future opportunities and barriers facing adherence apps. Practice description: Medication nonadherence is a common, complex, and costly problem that contributes to poor treatment outcomes and consumes health care resources. Nonadherence is difficult to measure precisely, and interventions to mitigate it have been largely unsuccessful. Practice innovation: Using smartphone adherence apps represents a novel approach to improving adherence. This readily available technology offers many features that can be designed to help patients and health care providers improve medication-taking behavior. Main outcome measures: Currently available apps were identified from the three main smartphone OSs (Apple, Android, and Blackberry). In addition, desirable features for adherence apps were identified and ranked by perceived importance to user desirability using a three-point rating system: 1, modest; 2, moderate; or 3, high. The 10 highest-rated apps were installed and subjected to user testing to assess app attributes using a standard medication regimen. Results: 160 adherence apps were identified and ranked. These apps were most prevalent for the Android OS. Adherence apps with advanced functionality were more prevalent on the Apple iPhone OS. Among all apps, MyMedSchedule, MyMeds, and RxmindMe rated the highest because of their basic medication reminder features coupled with their enhanced levels of functionality. Conclusion: Despite being untested, medication apps represent a possible strategy that pharmacists can recommend to nonadherent patients and incorporate into their practice.
Article
Full-text available
Background: CONSORT guidelines call for precise reporting of behavior change interventions: we need rigorous methods of characterizing active content of interventions with precision and specificity. Objectives: The objective of this study is to develop an extensive, consensually agreed hierarchically structured taxonomy of techniques [behavior change techniques (BCTs)] used in behavior change interventions. Methods: In a Delphi-type exercise, 14 experts rated labels and definitions of 124 BCTs from six published classification systems. Another 18 experts grouped BCTs according to similarity of active ingredients in an open-sort task. Inter-rater agreement amongst six researchers coding 85 intervention descriptions by BCTs was assessed. Results: This resulted in 93 BCTs clustered into 16 groups. Of the 26 BCTs occurring at least five times, 23 had adjusted kappas of 0.60 or above. Conclusions: "BCT taxonomy v1," an extensive taxonomy of 93 consensually agreed, distinct BCTs, offers a step change as a method for specifying interventions, but we anticipate further development and evaluation based on international, interdisciplinary consensus.
Article
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Mobile health interventions could have beneficial effects on health care delivery processes. We aimed to conduct a systematic review of controlled trials of mobile technology interventions to improve health care delivery processes. We searched for all controlled trials of mobile technology based health interventions using MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, Cochrane Library, UK NHS HTA (Jan 1990-Sept 2010). Two authors independently extracted data on allocation concealment, allocation sequence, blinding, completeness of follow-up, and measures of effect. We calculated effect estimates and we used random effects meta-analysis to give pooled estimates. We identified 42 trials. None of the trials had low risk of bias. Seven trials of health care provider support reported 25 outcomes regarding appropriate disease management, of which 11 showed statistically significant benefits. One trial reported a statistically significant improvement in nurse/surgeon communication using mobile phones. Two trials reported statistically significant reductions in correct diagnoses using mobile technology photos compared to gold standard. The pooled effect on appointment attendance using text message (short message service or SMS) reminders versus no reminder was increased, with a relative risk (RR) of 1.06 (95% CI 1.05-1.07, = 6%). The pooled effects on the number of cancelled appointments was not significantly increased RR 1.08 (95% CI 0.89-1.30). There was no difference in attendance using SMS reminders versus other reminders (RR 0.98, 95% CI 0.94-1.02, respectively). To address the limitation of the older search, we also reviewed more recent literature. The results for health care provider support interventions on diagnosis and management outcomes are generally consistent with modest benefits. Trials using mobile technology-based photos reported reductions in correct diagnoses when compared to the gold standard. SMS appointment reminders have modest benefits and may be appropriate for implementation. High quality trials measuring clinical outcomes are needed. Please see later in the article for the Editors' Summary.
Article
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When people encounter problems in translating their goals into action (e.g., failing to get started, becoming distracted, or falling into bad habits), they may strategically call on automatic processes in an attempt to secure goal attainment. This can be achieved by plans in the form of implementation intentions that link anticipated critical situations to goal-directed responses ("Whenever situation x arises, I will initiate the goal-directed response y!"). Implementation intentions delegate the control of goal-directed responses to anticipated situational cues, which (when actually encountered) elicit these responses automatically. A program of research demonstrates that implementation intentions further the attainment of goals, and it reveals the underlying processes. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This paper characterises the use of activity trackers as 'lived informatics'. This characterisation is contrasted with other discussions of personal informatics and the quantified self. The paper reports an interview study with activity tracker users. The study found: People do not logically organise, but interweave various activity trackers, sometimes with ostensibly the same functionality; that tracking is often social and collaborative rather than personal; that there are different styles of tracking, including goal driven tracking and documentary tracking; and that tracking information is often used and interpreted with reference to daily or short term goals and decision making. We suggest there will be difficulties in personal informatics if we ignore the way that personal tracking is enmeshed with everyday life and people's outlook on their future.